Medicare Advantage (MA) plans can provide significant benefits to their enrollees, but the plans can be difficult for patients to navigate alone. With the right tools, training, and resources, physicians can serve as a helpful and familiar resource for patients interested in enrolling in an MA plan.
Although physicians aren’t the only resource available for their patients, they can be a great place for patients to start learning. Physicians can help patients understand how Medicare Advantage plans might benefit the patient with respect to their individual health needs. For example, certain MA plans might provide patients with chronic illnesses additional benefits beyond those covered by traditional Medicare, such as dental, vision, hearing, expanded telehealth, over-the-counter medications, and transportation to and from the doctor’s office.
MA plans can help patients save significant amounts on their care. According to the Better Medicare Alliance, compared to traditional Medicare beneficiaries, MA enrollees on average spend about $1,400 less a year on their prescription drug costs. Out-of-pocket costs associated with facility stays can also be over seven times higher for traditional Medicare beneficiaries than MA participants. Depending on geographic location, many MA beneficiaries have access to MA plans with low or no premium. MA plans may be especially attractive to patients with chronic illnesses since they often provide additional benefits, lower cost sharing, and more coordinated care.
Studies have also linked enrollment in MA plans to improved patient outcomes. On average, beneficiaries enrolled in MA plans have a 43 percent lower rate of avoidable hospitalizations and higher rates of screening for cancer and depression than do beneficiaries in traditional Medicare. Twenty-one percent more MA patients “received a physician visit within 14 days of discharge than those in traditional fee-for-service Medicare.” Also, MA beneficiaries with “major complex chronic conditions” experienced “11 percent fewer inpatient hospital stays.”
How Physicians Can Help
If a patient asks their physician about enrolling in a MA plan, start an open dialogue about their health care needs and how an MA plan might address those needs. Tell patients which plans you participate in and share additional resources that discuss plan offerings. Provide objective information and let your patients make their decision. Resources such as Medicare.gov and Understanding Medicare & Medicare Advantage Plans can help patients navigate these plans.
Some physicians partner with organizations that act as a liaison between MA brokers and patients. These entities — physician enablement companies — can simplify the process for physicians by reaching out to patients and directing them to available resources.
Physician enablement companies can also provide patients with Medicare education sessions and can serve as a Medicare education resource center. During these education sessions, Medicare experts can help patients determine which plan is best for them. Physician enablement companies can serve as a trusted external resource who can help patients find the MA information they need.
These resources can help patients find MA information to choose a new plan or reevaluate their existing plan to determine if a change is appropriate. Although physicians should not be the only resource for MA information for their patients, they can provide a great introduction to help patients find the high-quality coordinated coverage they need.